Provider Demographics
NPI:1720195761
Name:SMITH, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3712
Mailing Address - Country:US
Mailing Address - Phone:360-876-6865
Mailing Address - Fax:360-876-5507
Practice Address - Street 1:1501 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3712
Practice Address - Country:US
Practice Address - Phone:360-876-6865
Practice Address - Fax:360-876-5507
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB00066Medicare ID - Type Unspecified